Micky Steinberg Form 9OFFICE OF THE CITY CLERK
pity aEMi-a-mi-B-each-,-].-7O.O--Convention-C-enter--Dr-i-va;--Mi-am-i-B-ea-ch--FL-33-139---------
www.m-iarnibeachf1.aov
Telephone: 305.673-7411
January 2, 2018
Florida Commission on Ethics
P.O. Drawer 15709
Tallahassee, FL 32317-5709
Pursuant to Sec. 112.3148, Florida Statutes, please find Quarterly Gift Disclosure State Form
(9), for the quarter ending September 2017, for the following City of Miami Beach Personnel:
0 Micky Steinberg — City of Miami Beach (Commissioner)
Should you have any questions or require any additional information, please contact me at
305.673.7411.
respectfully
Rafael E. Granado,
City Clerk
Attachment
Sent Certified Return Receipt
7017-1450-0002-2744-0228
Form 9 QUARTERLY GIFT DI CL W
1V- --- -- t T.J.11
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LAST NAME FIRST NAME MIDDLE NAME: NAME OF
i�i;� VC r..
MAILING ADDRIS§: OFFICE OIR"!, MTI0N*14ff-LVY
b rr4's s tt o
CITY. ZIP: COUNTY: FOR QUARTER ENDING (CHECK ONE): YEAR
LJMARCH LIJUNE WEPTEMBER Q DECEMBER 20_a
3313_- 9
PART A — STATEMENT OF GIFTS
Please list below each gift, the value of which you believe to exceed $100, accepted by you during the calendar quarter for which this statement is
being filed. You are required to describe the gift and state the monetary value of the gift, the name and address of the person making the gift, and the
date(s) the gift was received. If any of these facts, other than the gift description, are unknown or not applicable, you should so state on the form. As
explained more fully in the instructions on the reverse side of the form, you are not required to disclose gifts from relatives or certain other gifts. You
are not required to file this statement for any calendar quarter during which you did not receive a reportable gift.
DATE DESCRIPTION MONETARY NAME OF PERSON ADDRESS OF PERSON
RECEIVED OF GIFT VALUE MAKING THE GIFT MAKING THE GIFT
41k
10 10 4-C
ic rc
UO'CHECK HERE I I F .. C I ONTI'N'UED ON SEPARATE SHEET
PART B RECEIPT PROVIDED BY PERSON MAKING THE GIFT
If any receipt for a gift listed above was provided to you by the person making the gift, you are required to attach a copy of that receipt to this
form. You may attach an explanation of any differences between the information disclosed on this form and the information on the receipt.
Ll CHECK HERE IF A RECEIPT IS ATTACHED TO THIS FORM
IV 3A -affid rf � I roI
1, the person whose name appears at the beginning of this form, do
STATE OF FLS DA F
COUNTY OF
depose on oath or affirmation and say that the information disclosed
Sworn to (or affirmed) and subscribed before me this
day 20 /-'74.
of
herein and on any attachments made by me constitutes a true accurate,•
and total listing of all gifts required to be reported by Section 112.3148,
by
W.
Florida Statutes.
(Sign ture 0 NoWy Public -State of Florida)
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vz �e A-,,,�
IRE
(Print, Type, or Stamp Commissioned Name of Notary Public)
SIGR AT OF REPORTING OFFICIAL
Personally Known OR Produced Identification
Type of Identification
Notary public State of Florida
PART D FILING INSTRUCTION r Lifiam, R Hatfield
commission GG 044249
Of
This form, when duly signed and notarized, must be filed with the Commission
on Ethics, P.O. Dra 0' hysi-
cal address: 325 John Knox Road, Building E, Suite 200, Tallahassee, Florida
32303. The form must be filed no later than the last day of the calendar
quarter that follows the calendar quarter for which this form is filed (For example, if a gift is received in March, it should be disclosed by June 30.)
CE FORM 9 - EFF. 1/2007 (Refer to Rule 34-7.010(1)(g), F.A.C.)(Rev. 9/2014)
(See reverse side for instructions)
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